Bagrodia Aditya, Raman Jay D
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Endourol. 2009 Apr;23(4):627-33. doi: 10.1089/end.2008.0556.
To analyze and compare physician perspectives of musculoskeletal ergonomic parameters associated with open, pure laparoscopic, and robot-assisted prostatectomy.
Survey questions were designed to evaluate physician musculoskeletal discomfort during open and minimally invasive radical prostatectomy. The survey instrument was distributed to physician members of the Endourological Society (ES) and Society of Urologic Oncology (SUO) after approval from the respective organizations. We queried about the presence of chronic neck and/or back pain, relationship of musculoskeletal pain to operating, and pain characteristics associated with open, laparoscopic, and robot-assisted prostatectomies. Physicians were also asked to rank the three operative approaches with respect to associated pain and discomfort and to comment if practice patterns were impacted by these ergonomic variables.
There were 106 urologists who completed the survey. Chronic neck and/or back pain was present in 43% of urologists who responded to this survey. Of those surgeons with baseline neck/back pain, 50% indicated that operating caused or exacerbated this musculoskeletal pain. Furthermore, 25% of respondents indicated that musculoskeletal pain considerations impacted their choice of operative approach. Neck and/or back pain was experienced in 50%, 56%, and 23% of surgeons after open, laparoscopic, and robot-assisted prostatectomy, respectively. When ranking operative approach in order of decreasing amounts of associated pain, 32% indicated open>laparoscopic>robot-assisted, 28% responded that none caused pain, and 25% selected laparoscopic>open>robot-assisted. Three percent selected permutations, with robot-assisted causing the most discomfort.
Urologists who responded to our study indicate that open and laparoscopic prostatectomy cause more musculoskeletal discomfort than a robot-assisted approach. Of urologists performing robot-assisted prostatectomies, however, 23% suggested that this approach also was associated with physical pain. Furthermore, physicians do take into account ergonomic considerations when determining an operative approach. Studies with actual physician monitoring and electromyography are requisite to more thoroughly delineate the ergonomics of performing a radical prostatectomy.
分析并比较医生对于与开放性、单纯腹腔镜及机器人辅助前列腺切除术相关的肌肉骨骼人体工程学参数的看法。
设计调查问卷以评估医生在开放性及微创根治性前列腺切除术中的肌肉骨骼不适情况。在获得各自组织批准后，该调查问卷被分发给腔内泌尿外科协会（ES）和泌尿肿瘤学会（SUO）的医生成员。我们询问了慢性颈部和/或背部疼痛的存在情况、肌肉骨骼疼痛与手术的关系以及与开放性、腹腔镜及机器人辅助前列腺切除术相关的疼痛特征。还要求医生根据相关疼痛和不适对这三种手术方式进行排序，并评论这些人体工程学变量是否影响了手术模式。
有106位泌尿科医生完成了调查。在回复此调查的泌尿科医生中，43%存在慢性颈部和/或背部疼痛。在那些基线时有颈部/背部疼痛的外科医生中，50%表示手术导致或加重了这种肌肉骨骼疼痛。此外，25%的受访者表示肌肉骨骼疼痛因素影响了他们对手术方式的选择。在开放性、腹腔镜及机器人辅助前列腺切除术后，分别有50%、56%和23%的外科医生经历了颈部和/或背部疼痛。当按照相关疼痛程度递减的顺序对手术方式进行排序时，32%的人表示开放性>腹腔镜>机器人辅助，28%的人回答没有一种方式会引起疼痛，25%的人选择腹腔镜>开放性>机器人辅助。3%的人选择了其他排列方式，其中机器人辅助引起的不适最多。
参与我们研究的泌尿科医生表明，开放性和腹腔镜前列腺切除术比机器人辅助手术方式导致更多的肌肉骨骼不适。然而，在进行机器人辅助前列腺切除术的泌尿科医生中，23%表示这种手术方式也与身体疼痛有关。此外，医生在确定手术方式时确实会考虑人体工程学因素。需要进行实际医生监测和肌电图研究，以更全面地描述根治性前列腺切除术的人体工程学情况。
